Introduction

Fabricated or induced illness (FII) is a rare form of child abuse. It occurs when a parent or carer, usually the child’s biological mother, exaggerates or deliberately causes symptoms of illness in the child.

FII is also known as Munchausen's syndrome by proxy. Munchausen's syndrome, also known as factitious disorder, is a condition where a person pretends to be ill or causes illness or injury to themselves.

However, healthcare professionals in the UK prefer to use the term fabricated or induced illness, or factitious disorder imposed on another. This is because the term Munchausen's syndrome by proxy places the emphasis on the person carrying out the abuse, rather than the victim.

The term Munchausen's syndrome by proxy is still widely used in other countries.

Behaviours in FII

The term FII covers a wide range of cases and behaviours involving parents seeking healthcare for a child. This ranges from extreme neglect (failing to seek medical care) to induced illness. Behaviours in FII include:

a mother or other carer who convinces their child they are ill when they are perfectly healthy

a mother or other carer who exaggerates or lies about their child’s symptoms

a mother or other carer who manipulates test results to suggest the presence of illness – for example, by putting glucose in urine samples to suggest the child has diabetes

a mother or other carer who deliberately induces symptoms of illness – for example, by poisoning her child with unnecessary medication or other substances

How common is fabricated or induced illness?

It's difficult to estimate how widespread FII is, because many cases may go unreported or undetected. In an average population of one million people, around one child per year would be affected.

The British Paediatric Surveillance Unit (BPSU), which is a specialist unit that assists research into rare childhood conditions, carried out a study of FII cases. It identified 97 cases of FII in the UK over a two-year period.

However, it's likely that this figure underestimates the true prevalence of FII.

FII can involve children of all ages, but the most severe cases usually involve children under five.

In over 90% of reported cases of FII, the child’s mother is responsible for the abuse. However, cases have been reported in which the father, foster parent, grandparent, guardian, or a healthcare or childcare professional was responsible.

Motivation

It's not fully understood why FII occurs.

In cases where the mother is responsible, it could be that the mother enjoys the attention of playing the role of a "caring mother".

A large number of mothers involved in cases of FII had a previous history of unresolved psychological and behavioural problems, such as a history of self-harming, or drug or alcohol misuse, or have experienced the death of another child.

A high proportion of mothers involved in FII have been found to have so-called "somatoform disorders", where they experience multiple, recurrent physical symptoms. A proportion of these mothers also have Munchausen's syndrome.

A high proportion of mothers also have a type of mental health problem called borderline personality disorder, which is characterised by emotional instability, impulsiveness and disturbed thinking.

There have been several reported cases where illness was fabricated or induced for financial reasons – for example, to claim disability benefits.

Child protection

FII is a child protection issue and cannot be treated by the NHS alone.

Medical professionals who suspect FII is taking place should liaise with social services and the police, and must follow local child protection procedures.

If your job involves working with children – for example, if you are a nursery worker or teacher, you should inform the person in your organisation who is responsible for child protection issues.

If you don't know who this is, your immediate supervisor or manager should be able to tell you.

If you suspect that someone you know may be fabricating or inducing illness in their child, it's not recommended that you confront them directly. A direct confrontation is unlikely to make a person admit to wrongdoing, and it may give them the opportunity to dispose of any evidence of abuse.

You can contact your local social services department or telephone the NSPCC’s child protection helpline, which is open 24 hours a day, seven days a week, on 0808 800 5000.

Treatment

In cases of FII, the first priority is to protect the child. This may involve removing the child from the care of the person responsible. If the child is in hospital, it may involve removing the responsible parent or carer from the ward.

Once the child is safe, it may be possible to treat the parent or carer's underlying psychological problems. However, parents or carers involved in FII are difficult to treat, because most do not admit their deceptions and refuse to admit their abusive behaviour. Therefore, in many cases, the child is permanently removed from their care.

Outlook

Children affected by FII can experience long-term consequences in terms of their physical health, as well as significant psychological and emotional trauma.

A BPSU study found that one in four victims of FII still had significant physical and/or psychological problems two years after the abuse had stopped.

In cases involving administering unnecessary medicines or other substances, it's estimated that around 1 in 16 will die as a result of this abuse. A further 1 in 14 will experience long-term or permanent injury.

Munchausen’s syndrome

Viewing video content in NHS Choices

If you do not have a version of the Flash Player you can download the free Adobe Flash Player from Adobe Systems Incorporated.

A psychiatrist explains the motivation behind Munchausen’s syndrome, also known as factitious illness, where someone pretends to be ill or causes symptoms in themselves. This can include inflicting wounds or tampering with blood and urine samples. He also explains the importance of getting treatment and describes another form of the condition where a person fabricates an illness in someone in their care.

Media last reviewed: 08/01/2015

Next review due: 08/01/2017

Media controversy

There has been some controversy in the media regarding FII, with some commentators suggesting that it's not a real phenomenon.

However, there's a great deal of evidence to suggest the condition does exist. The evidence of abuse includes hundreds of case files from more than 20 different countries, the confessions of mothers and other carers, the testimony of children and secret video footage.